CARE HOMES FOR OLDER PEOPLE
Willow Lodge 59 Burdon Lane Cheam Surrey SM2 7BY Lead Inspector
Alison Ford Unannounced Inspection 8th April 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Willow Lodge Address 59 Burdon Lane Cheam Surrey SM2 7BY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8642 4117 020 8642 7729 trilodge@hotmail.com Trilodge Limited Mrs J E Grant Asha Paroomatee Gobin Care Home 27 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (0) of places Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Two (2) places for service users under the age of 65, with dementia, can be accommodated. 3rd April 2007 Date of last inspection Brief Description of the Service: Willow Lodge is a large detached residence in Cheam that is registered, with the Commission for Social Care Inspection, to provide nursing care for up to twenty-seven people with dementia. The home is owned by Trilodge Ltd and run as a family business with two of the directors, both nurses, frequently working in the home alongside the registered manager. The home prides itself on offering a high standard of care in comfortable, safe and homely surroundings in which the wellbeing of the residents is of prime importance. It is well served by public transport links, near to the station and local shops. Accommodation is provided in a mixture of single and double rooms arranged over two floors and there is both a passenger and stair lift. There are two spacious lounges, a conservatory and an attractive well-maintained rear garden. Various adaptations throughout ensure that all areas of the home are accessible to residents including those who need walking aids or wheelchairs. At the time of this inspection fees range from £600 - £7O0 a week, depending on the level of care that is needed and the choice of room. Some extra charges would be payable for services such as hairdressing and these would be discussed prior to admission. The home has produced a Statement of Purpose and a Service User Guide, which describe the aims and objectives of the home and the facilities and services that are available. These and a copy of the latest inspection report can be obtained from the home. Inspection reports can also be obtained from the Commission for Social Care Inspection or downloaded from the internet. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 5 Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes.
This unannounced visit to the home was undertaken as a part of the inspection process for the year 2007/2008. When writing the report, consideration has also been to given to comments we have received from people who use the service and also information that the home has given us including notifications of incidents and complaints. Before the inspection, the homes manager completed and sent to us an Annual Quality Assurance Assessment (AQAA). This gives us information about the home, and how well they consider they have met the needs of the people who live there. It also tells us about any plans that they may have for the future. During the inspection visit a partial tour of the premises was undertaken and many of the twenty-six residents currently living in the home were spoken to and asked for their opinions about the home. The Registered Manager, one of the Registered Providers and several members of staff were also spoken with. Various records that the home is required to keep, as evidence of its commitment to the protection and health and safety of its residents, were seen and also a sample of care plans which identify the help and support that residents need and show how their assessed health care needs are met. At the time of the last inspection there was an ongoing complaint, which was dealt with according to the local authority “Safeguarding of Adults Procedures”. This was found to be unsubstantiated and has now been closed. . What the service does well:
The home offers a well-maintained and homely environment for up to twentyseven people with dementia. It is clean and warm and specialist adaptations ensure that all areas are accessible to people who may have disabilities. Assisted baths and toilets, suitable for wheelchair users, are throughout the home and there is a pleasant garden where residents can sit in the summer months. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 7 On the same day as the inspection, fitters were laying new carpets in the home, blinds were being fitted and guttering was being repaired. Then someone arrived to clean out the fish tanks. Staff in the home were trying to ensure that there was a minimum of disruption to residents, during this time, although one person was complaining because breakfast had been served slightly earlier than usual and he had not yet had a shave. This was eventually addressed to his satisfaction. The home has developed a Statement of Purpose and a Service User Guide, which are given to residents or their representatives at the time of admission and these explain the range of services that the home can offer. These give people the information that they need to help them decide whether the home will be suitable for them. Their views on how well the home meets these stated aims and objectives are monitored annually, when questionnaires are sent out to them and their representatives. Prior to their admission, all new residents would be visited by a senior member of the nursing team. An assessment of their physical and psychosocial needs is undertaken to make sure that they can be met. This information then becomes the basis for a care plan, which identifies the support that will be needed. These plans are reviewed regularly to ensure that any changes are identified and that all of the staff are helping the resident in the way that they prefer. All of the people living in the home, that were spoken with, agreed that they are treated kindly and many staff members have worked in the home for several years. This continuity of care helps residents to feel safe as they see the same familiar people all the time. Some people commented that “ its nice here”, “staff are always very nice” and “they were looked after very well”. Organised activities are held daily in the home, for those who wish to join in, and various pieces of craftwork that residents have done are displayed on the walls. Birthdays and other occasions are celebrated and relatives and friends are encouraged to visit as much as they would like to. Residents were complimentary about the meals served in the home and the two cooks have worked there for many years. They know everyone well and exactly what they like or dislike. Choices are always available and special diets can always be catered for. Complaints about the home are few and all staff have received training in issues around the recognition of adult abuse. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 8 The Registered Manager of the home has a background in nurse education and ensures that the provision of staff training is given a high priority. Training sessions are arranged according to the needs of those people using the service so that all staff have the skills that are required to meet their needs. Health and safety practices with in the home are good, comply with current legislation and provide evidence of the homes commitment to the protection and wellbeing of residents and staff. What has improved since the last inspection? What they could do better:
No new requirements were issued at this inspection. The Annual Quality Assurance Assessment highlights a need to continue to gain the views of all those people who use the service and their representatives, by having more informal meetings with them. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 9 The Registered Manager will also be exploring the possibility of undertaking an accredited Quality Assurance programme such as Investors in People. She has also highlighted the importance of continuing to invest in the staff working in the home through training and development in order that they are always able to meet the needs of the people that they are caring for. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who user this service are able to access all of the information that they need, to in order to help them decide whether the home will suit their needs. A comprehensive pre-admission assessment generally ensures that their healthcare needs can be met. This home does not offer intermediate care. EVIDENCE: The home has developed a Statement of Purpose and a Service User Guide, which are revised annually. These provide information about the care and facilities that are provided by the home. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 12 Copies of the Service User Guide are given out during the admission process and a copy has been put into each resident’s room for them and their families to refer to. The care plans of five residents, who had moved into the home since the last inspection, were assessed. They all contained evidence that a comprehensive pre-admission nursing assessment had been undertaken which was then used to form the basis of subsequent care planning. Concerns were raised about the needs of one resident who had just been admitted into the home. During the inspection he became quite agitated and disruptive and this necessitated them having to return to hospital for further assessment and treatment. In order to avoid vulnerable frail people being transferred to placements that might not be suitable for them, care must be taken to ensure that as much information is gained prior to possible placements. However, on this occasion it would seem that not all of the relevant information had been available from the hospital when the pre-admission assessment had been undertaken. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service all have an individual care plan, reviewed regularly, which identifies the care and support that they need. They can be confident that they will always be treated in a manner, which ensures that their dignity and privacy are respected and that the medication procedures within the home will protect them. EVIDENCE: Each resident has a full assessment when they come into the home and a plan of care is implemented. Wherever it is possible, residents or their relatives are encouraged to be involved in this process and they sign the care plan to indicate that they agree with it. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 14 Five care plans, of people admitted since the last inspection, were assessed and although, they are quite bulky and contain a lot of information, it is all well organised and easy to understand. Problems are all identified along with the support and interventions that will be required. These are reviewed regularly to make sure that any changes are noted. Risk assessments, nutritional screening and moving and handling assessments are all in place and also regular review of factors, which may predispose to pressure sore formation. Several examples of pressure relieving equipment were in use in the home. The majority of residents are registered with one doctor and they all have access to chiropody dental and optical services. The tissue viability nurse is consulted to advise about wound care and other healthcare professionals visit the home as required. In order to emphasise the need to treat the people who live in the home as individuals and appreciate there past lives and achievements, work is ongoing to produce “life histories”. Collecting this information also allows activities to be planned, which will suit their interests. Residents told us that staff “are always very kind”. Their personal care would always be carried out in their bedrooms and staff were seen to be approaching them with kindness and respect. They seemed to have the time to talk with them and there is a very happy and friendly atmosphere in the home. The medication system has been changed to a monitored dosage system. Storage, administration and records were all in order at this visit and the supplying pharmacist will be undertaking regular audits and training sessions in the home. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service consider that it meets their needs. They enjoy the activities, which are arranged for them and their visitors are always welcome. The meals that are served are varied and nutritious and suit their preferences. EVIDENCE: The advanced stages of dementia, of many of the residents, limits the amount of choices that they can make in their daily lives however, they are encouraged to select their clothes and what they would like to eat. An activities organiser is in the home five days a week and she ensures that a varied programme of activities takes place in the home. Residents are supported to join in if they wish to and examples of their artwork are displayed throughout the home along with photographs of events that have occurred. Musical entertainers also visit the home on a regular basis. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 16 Relatives are always made welcome and they are encouraged to join in the Christmas and summer parties that are held in the home. Local church members visit and Holy Communion is available for those who wish to participate. Some residents are taken to the local church on Sundays. The lunchtime meal was served during the visit. All the residents confirmed how much they had enjoyed it; menus were seen and were varied and nutritious. A choice of hot supper is also offered in the evening. The cooks have worked in the home for some time, they are aware of all of the resident’s particular likes and dislikes and would always offer a choice. Menus are revised regularly although attempts to update them were not particularly successful; residents prefer more traditional dishes. Records of the food that residents have eaten are kept, they are weighed monthly and any fluctuations are monitored and addressed. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service have access to a complaints procedure, which ensures that any concerns that they have will be dealt with promptly and effectively. There are safeguards in place to ensure that they are protected from abuse and from people who have been judged as unsuitable to work with vulnerable adults. EVIDENCE: One of the Directors has responsibility for managing concerns and complaints and there is a clear complaints procedure in place. Copies of this are in resident’s bedrooms. At the time of the last inspection there was one complaint, which was ongoing and being addressed through the local authority safeguarding procedures. This was deemed to be unsubstantiated and has now been closed. There have not been any other issues raised, since that time, either to the home or to The Commission. All staff have received training in recognising and reporting suspected abuse and this training is updated regularly.
Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 18 No new member of staff is employed before appropriate checks have been completed regarding their suitability to work with vulnerable people. Evidence of this clearance was seen in personnel files of those people employed since the last inspection. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service live in a well-presented, well-maintained, homely and clean environment, which meets their needs EVIDENCE: Willow Lodge is situated in a pleasant residential road close to local amenities. There are parking facilities to the front of the home. It is well maintained, complies with fire safety regulations and is presented in good decorative order. Furniture and furnishings are homely and adaptations have been made throughout the home to ensure that it meets the needs of the residents. At the time of the inspection work was in progress to replace all of the carpets and a new kitchen has been put in since our last visit.
Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 20 The range of communal space means that there can be different activities happening throughout the home at the same time, which suit the varying capabilities of the residents. There is a large rear garden, with a lawn, flowers and shrubs. Garden furniture means that it is well used during the summer months. Resident’s bedrooms are light and airy, all of them have washbasins and shared rooms have privacy screens available. Residents have been encouraged to personalise their rooms with items from home to make their surroundings more familiar and to retain their individuality. They told us that they had “nice bedrooms” and that they “had been able to bring things in from home” It was noted that one of the bathrooms upstairs was a bit scruffy, however it is apparently rarely used and there are plans to redesign it as a wet room. This will give residents the option of a shower or bath. The home was, as usual, very clean and free from malodour. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service know that there will always be enough staff in the home to meet their needs and that they have all undergone training which will help them understand how to support and care for them. Recruitment policies are in place to help to protect residents and maintain their safety. EVIDENCE: Staff turnover is very low in this home; this means that residents enjoy continuity of care and a feeling of safety and familiarity. Four new members of staff had been employed since the last inspection and their files were seen. All of the necessary pre-employment checks had been carried out before they started work in the home. This helps to make sure that residents are protected from those who have been judged as being unsuitable to work with vulnerable people.
Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 22 Staff training continues to be given high priority in the home and exceeds the minimum standard with all members of the staffing team being encouraged to attend training courses, relevant to the work that they perform. Many of them have undertaken several courses at NVQ level 2. Future training is planned for the forthcoming year, which will include equality and diversity, palliative care, infection control, nutrition and basic food hygiene and dementia awareness. There are also plans to arrange training to inform staff about the implications of The Mental Capacity Act. At the time of this inspection there were sufficient staff, both trained nurses and carers, to have time to support residents and off duty rotas showed that this was always so. Additional domestic, laundry and catering staff are employed. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that an experienced, competent and well-qualified team manage the home in their best interests. Policies and procedures are in place to protect them and maintain their safety. EVIDENCE: The Registered Manager of the home, a registered nurse, has many years experience in working with this client group and a background in nurse education. The two directors are also both trained nurses, and work in the home. This strong management team is able to lead by example and support the staff. There is a welcoming relaxed atmosphere in the home and the low
Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 24 staff turnover indicates their satisfaction with their working conditions. There are regular meetings held so that they are kept updated and aware of what is happening. Relatives have always told us that they feel able to approach the management team, if they have any concerns and an annual quality assurance questionnaire is sent out to try and gain the views of residents and their relatives in a more formal process. The manager is also exploring ways to gain a Quality Assurance Accreditation such as Investors in People in the future. The home does not take responsibility for the finances of any of the residents; all of them have relatives or representatives to do this for them. The Annual Quality Assurance Assessment states that all of the equipment and services in use in the home are well maintained and checked regularly and policies and procedures are in place to ensure their protection. Records of incidents and accidents are maintained and we are always informed of any untoward incidents affecting the welfare of any of the residents. Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Willow Lodge DS0000019131.V361515.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
